a close up of someone getting their blood pressure checked

Blood pressure control is fundamental to keeping your heart, kidneys and brain healthy. But sometimes it is far from easy! Doctors may need to prescribe more than one drug, but combining BP drugs must be done only with great care.

Combining BP Drugs Can Be Risky:

Q. My doctor has me taking an ACE inhibitor blood pressure medication called lisinopril and an ARB called Diovan (valsartan). These drugs make me dizzy and sap my energy. I have headaches, heart palpitations and gastrointestinal problems. Whenever I complain I am pretty much told to suck it up and that my symptoms are all in my head.

At my last doctor’s visit, my blood pressure was 140/90. Instead of getting an “attaboy” and congratulated, I was told to up the dosage.

Thoughts?

A. Yikes! The very first question to ask your doctor is whether it is appropriate to combine lisinopril (an ACE inhibitor) with valsartan (Diovan) which is an ARB (angiotensin receptor blocker). A Canadian study found that combining ACE inhibitors with ARBs increased the risk of kidney damage and potassium overload, especially in older patients. The European Medicines Agency has warned that no two types of drugs that affect the renin-angiotensin system should be prescribed together.

No Aliskiren with ACE Inhibitors or ARBs:

The FDA put out an alert about combining similar drugs in certain patients. On April 20, 2012, the agency warned doctors to be cautious about prescribing aliskiren (Amturnide, Tekturna, Tekturna HCT, and Tekamlo) in combination with ACE inhibitors or ARBs such as candesartan (Atacand), irbesartan (Avapro), olmesartan (Benicar), losartan (Cozaar), valsartan (Diovan), telmisartan (Micardis) or eprosartan (Teveten) in patients with diabetes or kidney problems.

Aliskiren affects the renin-angiotensin system, as do ACE inhibitors and ARBs. The combination of aliskiren and an ARB increased the risk for high potassium levels and kidney damage in people dealing with diabetes. That same day, the drug manufacturer Novartis withdrew its drug Valturna, a fixed combination of aliskiren and valsartan, from US markets.

No Advantage to Combining ACE Inhibitors with ARBs:

More recently, a review of large trials (more than 1,000 participants) found that both types of drugs can be effective at lowering blood pressure and protecting the heart (Therapeutic Advances in Cardiovascular Disease, June 2016). The author cautions against combining BP drugs from these two classes, however.

How Low Should You Go?

We get concerned whenever we hear that older people are encouraged to strive for a blood pressure reading of 120/80 with medications. When anti-hypertensive drugs cause dizziness, fatigue, heart palpitations, headaches and digestive distress, the “cure” may be causing more problems than the condition being treated. We wrote more about this controversy here.

ACE Inhibitor Cough:

Visitors to this website have described other drug-induced side effects that have often gone under appreciated:

“I took lisinopril for a few weeks before realizing it was causing an unacceptable problem with coughing (coughing until I threw up!) My doctor put me on Diovan. It was more costly, but it worked without the coughing.” Glenda


“I took lisinopril for many years and every time I complained to my doctor who had prescribed it, about the constant nagging cough, he just prescribed cough medicine! He never told me it was the lisinopril!

“When the coughing was so bad I wet myself, he prescribed a drug for incontinence!

“After 8 years, I changed doctors due to reaching 65 and going on Medicare. (My former doctor didn’t take Medicare patients.) The new doc took me off the lisinopril immediately (explained that was the connection) and put me on losartan; the cough went away in less than a week. No more cough equaled no more losing control of bladder so he told me to toss the cough med and the incontinence med!” C.R.L.


“My doctor actually told me that the lisinopril cough was good for me! He gave me some medical mumbo-jumbo explanation of how coughing uncontrollably all day and night was not bad!” B.L.


“When I asked my doctor about my horrible dry cough after taking Benicar for a long time, she assured me it must be allergies as my lungs were clear. Also, I had experienced nerve pain in my feet and itching all over. I stopped taking Benicar. My BP went up to 135/75 and my cough stopped as well as the pain in my feet and itching.” G.G.


“I took Benicar and Cozaar for a year plus, and developed a horrible cough. Cardiologist said could not be the medicine. Internist said it could.” E.M.F.


We have received hundreds of reports of ACE inhibitor cough linked to drugs like lisinopril. To read other stories, here is a link.

To learn more about other ways to control blood pressure, we suggest our book, Best Choices from The People’s Pharmacy. We offer a great many natural approaches to controlling hypertension with food and supplements. You can also find hints in our Guide to Blood Pressure Treatment.

All our publications can be found here.

Do not let your blood pressure medicine cause complications that affect the quality of your life. Always communicate with your physician what is going on. Share your own story with such medications below. What has worked for you without causing side effects.

Revised 7/14/16

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  1. J. David
    Springfield, MO, USA
    Reply

    The combination of ACE’s and ARB’s in patients (even without renal vascular obstructions) is edgy medicine – but has helped some CHF patients and taught those who noticed that our ideas about what is a high potassium need to be reworked. The first group to use this combo was in Boston probably 20 years ago – the admissions for CHF dropped sharply but the orthopedic problems allowed quite a bit of the study to be done in the hospital. I always thought hypotension and falls in this elderly cerebral circulation impaired cohort explained the admissions.

  2. Marge
    San Antonio, TX
    Reply

    How are you tapered off of your blood pressure medicine? I’m taking:
    40 mil of Benazepril
    10 Amlodipine
    12.5 Carvedilol twice a day
    Oxygen at night

    I feel like all this medicine is ruining my quality of life. I would like to try vitamins and minerals. I can just do a little work and have to stop and rest.

    I intend to talk to my doctor this month. The last time I saw him, he made me take a test that was blowing out a fire. I could do it and he said I did 300 percent better then he thought I could. I would appreciate any information I can get.

  3. cpmt
    Reply

    Can someone indicate or tell me what ACE (for HBP) & ARB ? Thank you.

  4. O.G.
    SC
    Reply

    I agree with Lee: there seems to be a lot of people out there who need new doctors. The physician who argued the virtues of uncontrollable coughing would be right up there on the top of my “lose” list.

    And to the first year pharmacy student: keep up the good work. I’d rather get advice from my pharmacist on just about any given day.

  5. Aya
    Reply

    Thanks for sharing all of these reviews. They’ve helped me a lot. I’m going to try to get off lisinopril and on to something else, as I believe it is responsible for my bowel problems.

  6. Leslie
    Texas
    Reply

    I am 41 years old and am currently taking the following medications:

    Labetalol – 200mg twice a day
    Lisinopril – 20 mg in the morning
    Candesartan – 32 mg cut in half, once at night
    Metformin – 500 mg twice a day
    Pravastatin – 20 mg at night
    Ambien as needed for insomnia – I only use it maybe three or four times a month

    When I first started on the three bp meds, I was in the hospital, and my bp upon discharge was 122/83. That was two weeks ago and it has already started to creep back up. I’m also getting flushed in the evenings, like hot flashes, and leg cramps. Is this normal or should I start looking for something else to take for the bp?

    Thanks

    • cpmt
      Reply

      You should try hybiscus flowers with fresh ginger (1/2 cm.) and 1 stick of cinnamon. It works for my BP.

  7. Chris
    USA
    Reply

    I’m a first year pharmacy student and even I know not to combine ACE inhibitors like Lisinopril with ARBs like Losartan. Doctors really need to know more about the medication they are prescribing to their patients. But its ok, a good pharmacist will always tell you if your doctor is prescribing you medications that do not work together.

  8. Kgwhitmyre
    Reply

    Ruth, would you share your turmeric, Hawthorne, and cayenne regime?
    Kgw

  9. LW
    Reply

    Your site is very informative.
    Where do you get your research from?
    One of my family members is 83 and on all of the following.
    I would appreciate knowing if there any contraindications for taking together lisinopril/Zestril Amlodipine/Norvase, Levemir, for elevated B/P.
    Metformin, Onglyzap and insulin for type 2 diabetes.
    Cosoptic, and Lotemax drops both for- glaucoma
    Are any of these drugs prone to cause diarrhea, or dark stools?
    Thank You

  10. Bjc
    Reply

    I have taken Lisinopril for years and suffered with Colitis. Mt gastroenterologist treated me. But it was always recurring.
    After being taken off of Lisinopril the colitis stopped. It has been 8 months.

  11. Ruth
    Reply

    Lisinopril, Losartan, and Cozaar are all bad about having fatigue as a side effect, as in, lay on the couch and sleep all day fatigue! Once I got off all of them life improved tremendously. I’ve been using a combination of Turmeric, Hawthorn, and Cayenne the last couple of years and blood pressure is in the acceptable range for my age. The only side effect is occasional heartburn when I forget to take them during a meal!

  12. PattiC
    Reply

    My husband is on Lisinopril and I believe it’s caused low sodium, below the range of the blood tests 131 range 134-144. The test a year ago saw his potassium creep up to the top of the lab range 3.5-5.2 it was 5.1 and this year it was 5.3 high same lab range. Nothing from the doctor but it worries me.
    The potassium had always been mid range for as long as it’s been taken. Ever since he’s been on this bp med the sodium came in low, below range. Does anyone else have a similar experience?

  13. Lee
    Reply

    “Yikes” is an understatement. Time to get a new doctor. What a pompous jerk. He must be getting big kick-backs from the drug company.

  14. Mary T.
    Reply

    I was on Lisinopril for a long time and also had a cough. I finally decided, after reading your column and newsletter about drug side-effects, to look those up.
    I confronted my doctor and he changed the med to Diovan. The cough went away but I was very dizzy. He then cut it in half but it still caused problems. Then he changed to Chlorthalidone and that was worse. It caused dizziness, irregular heartbeat and general bad feeling.
    I asked if I could go off all this and just take the Maxide and he said we can try that. I am 79 and there are new guidelines for that age group. I am doing fine with BP ranging from the 120s to 130s and have discovered I am free of some aches and pains that I attributed to arthritis!!
    People should become educated about drugs and speak up when you think there are problems. If your doctor does not listen, perhaps it is time to change!!!

  15. Penny H.
    Reply

    I developed high blood pressure (and diabetes) after some steroid injections for back pain. The doctor put me on Lisinopril and Diovan for my blood pressure and Glimepiride for the diabetes. That was fifteen years ago and that doctor has since retired. I asked my new doctor if I could go off the blood pressure meds since I have never had a high b.p. reading again.She said I could ditch the Diovan and took me off the hctz version of Lisinopril because fluid retention has never been a problem.
    Both doctors are internists. They are supposed to be up on these things. I’m on Medicare. My pharmacies (mail-order and local) are useless at monitoring drug interactions. So, I spend more time than I care to on the web checking out my health problems vs. my medications. It’s scary to think about the millions of seniors without web access who are getting too many meds without any checking for interactions and/or adverse reactions.

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